Stress and Trauma Symptoms in Young Palestine Refugee Children Following the May 2021 Escalation in Gaza

Objective

Children in the Gaza Strip have lived their entire lives with chronic economic and political insecurity punctuated by periodic escalations of overt combat. Clinicians need to learn how children raised in these conditions respond to escalations of threat. This study investigated the prevalence of stress and trauma-related symptoms and functional impairment among young Palestinian children following the May 2021 escalation in Gaza.

Method

Survey (conducted in 2021) of first-year elementary school students aged 5 to 7 years from all 5 Gaza Strip governorates (n = 11,646). Symptoms were measured in joint parent-child interviews using an adapted version of the Acute Stress Checklist for Children (ASC-Kids) administered after the May 2021 escalation. Children were classified as having no exposure to the May 2021 escalation, personal exposure (witnessed or experienced injury or property damage), subjective experience of fear (recalled feelings of fear at the time), and combined personal and subjective exposure.

Results

Personal and/or subjective exposure was reported by 75.9% of children. ASC-Kids scores increased as a function of exposure: none<personal<subjective<combined. However, the relationship between exposure and ASC-Kids scores was stronger in some governorates than others and was attenuated among children from higher-income families. Functional impairment was found in 38.1% of the children, and the rate increased with the level of exposure. ASC-Kids scores were not related to the time of assessment.

Conclusion

Exposure to the May 2021 escalation was related to elevated stress and trauma-related symptoms and higher rates of functional impairment. Feelings of distress at the time of the escalation were stronger predictors of later problems than were reports of exposure to injury or destruction alone. The study findings suggest ways of identifying children who could be candidates for preventive interventions following escalations of violence.

Plain language summary

After the escalation of combat in Gaza in May 2021, many more elementary school-aged children reported a subjective experience of fear than directly witnessed violence. Subjective experience of fear strongly predicted mental health and functional impairment in the following months, with children in lower income families being even more likely to report ongoing difficulties. The authors suggest that promoting a sense of security and supporting families’ basic needs may help mitigate feelings of distress in young children living through periods of war.